ACUTE VASCULAR RESPONSE TO HEMODIALYSIS AS MEASURED BY SERUM SYNDECAN-1 AND ENDOTHELIN-1 LEVELS, AS WELL AS VASCULAR STIFFNESS

Objective:

End-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) have very high cardiovascular risk. Acute vascular changes during dialysis mediated partially by factors of the endothelium may have a crucial role in the cardiovascular (CV) disease of HD patients.

Aim: To study acute vascular changes during HD measured by applanation tonometry and to assess the role of syndecan-1 (SDC-1), endothelin-1 (ET-1), and traditional and non-traditional CV risk factors in these changes.

Design and method:

Patients and methods. 29 consecutive chronic HD patients (median age: 65.6±10.4 years; 52% men) were included in the study. Pre-, mid-, and post-HD plasma SDC-1 and ET-1 levels and routine biochemical parameters were measured. Applanation tonometry (SphygmoCor, AtCor Medical) was performed before HD.

Results:

As assessed by trend analysis SDC-1 levels increased significantly during HD (p=0.004). ET-1 levels were decreasing during HD. Male patients had significantly higher ET-1 levels than women. Patients were divided into 2 groups based on their pulse wave velocity (PWV), PWV>=12 m/s and PWV<12 m/s). Pre-HD and mid-HD SDC-1 levels were significantly higher in the group with PWV>=12 m/s (10.174±2.568 vs. 7.928±1.794 ng/ml, p = 0.013, and 10.319±3.482 vs. 8.248±1.793 ng/ml, p = 0.044, respectively). Post-HD ET-1 levels were significantly higher in the patient group having PWV>=12 m/s (10.88±3.00 vs. 8.05±3.48 pg/l, p = 0.027). Patients having PWV>=12 m/s had significantly higher pre-HD peripheral and aortic systolic blood pressure than the patients having lower PWV (147.4±73.3 vs. 134.1±72.2 mmHg, p = 0.038, and 130.7±16.6 vs. 122.5±14.9 mmHg, p = 0.016, respectively). Mid-HD and post-HD blood pressures were not different. We found a positive correlation between total cholesterol and the decrease in SDC-1 levels during HD (r = 0.539; p = 0.008). Pre-, mid-, and post-HD SDC-1 correlated significantly with the ultrafiltration volume during HD (r = 0.432, p = 0.019; r = 0.377, p = 0.044; and r = 0.401, p = 0.012, respectively).

Conclusions:

SDC-1 and ET-1 may contribute to the vascular changes observed during HD, and they have correlations with some traditional and non-traditional CV risk factors.